Eating disorders don’t exist in isolation—they are deeply connected to relationships. From the “why” behind disordered eating and movement patterns to the healing process, relationships have the power to either support or harm recovery.
In today’s episode of The Appetite, Opal’s Co-Founder & Clinical Director, Kara Bazzi, LMFT, sits down with therapist Nikki Wolf, LMHCA, to explore the role of relationship therapy in eating disorder treatment. They dive into what support people should (and shouldn’t) do when walking alongside a loved one struggling with food, body, and movement concerns.
Learn more about Opal’s Family+Relationship Therapy, including our curated list of resources for family and loved ones of those struggling with eating disorders.
To reach Nikki Wolf you can find her at Opal and at Wolf Heart Counseling, which gives details about her Family + Relationship Support Group – for loved ones of people with eating disorders.
F.E.A.S.T. –Families Empowered and Supporting Treatment of Eating Disorders
Connect with Opal:
Thank you to our team…
Editing by David Bazzi
Music by Aaron Davidson: https://soundcloud.
Sound engineering by Ayesha Ubayatilaka at Jack Straw Studios
Transcription by Rev.com
Kara Bazzi (00:07):
Hello and welcome to the Appetite, a podcast brought to you by Opal Food and Body Wisdom, an eating disorder treatment clinic in Seattle, Washington. It is a podcast about all things food, body movement, and mental health. I’m Kara Bazzi, a co-founder and clinical director for Opal, a licensed marriage and family therapist, as well as your host for today. So welcome to today’s episode. I’m excited to be joined by Nikki Wolf, one of the incredible therapists at Opal and Nikki specializes in family and relationship therapy, working closely with clients to explore how relationships can both contribute to the life force of an eating disorder and serve as a powerful resource for healing. She also leads groups at Opal focused on these dynamics, helping individuals navigate the complexities of connection with others and recovery as someone who shares a deep passion for family and relationship therapy. I’m really looking forward to this conversation, so let’s dive in. Welcome Nikki.
Nikki Wolf (01:07):
Thank you. I’m excited to be here.
Kara Bazzi (01:10):
I’m excited to have you. So I would love to start just by giving listeners a little bit of background information on you, how you came to be interested in doing the work of eating disorders, and in particular the family and relationship work. This is a part of the work that a lot of people are intimidated by of doing the family system work, so I’d love to hear how you got here.
Nikki Wolf (01:36):
Yeah, so eating disorders, I have a young adult child daughter, and when she was in high school and an adolescent, I became very aware of the prevalence of disordered eating among her peers. It wasn’t necessarily at that time I felt like I need to go work in this field. This is my second career as you know, I was working as an acupuncturist before it was when I was in grad school. I found Opal and your approach, Opal’s approach, at least from the R-O-D-B-T perspective was new to me and it was really exciting and inspiring and I knew I wanted to be a part of it. So it was kind of a slow burn. The family systems piece that’s very personal to me. I’ve done a lot of work personally around my family of origin, working with my husband and his family of origin, and it’s been a really powerful journey to healing my current relationships, how I show up in my relationships now, understanding that systems piece from my childhood and my own relationship with my family. So there’s been a lot of healing for me in that and I just really want to be a part of that for others and give others that opportunity to change how they’re showing up in their relationships.
Kara Bazzi (03:07):
Cool. Yeah, I think of how I know who our listeners are, even if we haven’t had our own personal experience with an eating disorder or disordered eating, most of us have been in relationship with somebody who struggled in this way. So I would love for you to talk a little bit more about your experience in working with loved ones with parents, spouses, partners, roommates, friends, what have you typically experienced as the loved ones? Posture towards the person struggling with an eating disorder. And I guess I would also want to say to give some context, we do family and relationship therapy at Opal and we have historically served clients that are 18 and older now we are taking clients from 16 years and older, but we have worked with most of our clients who are no longer living with their family of families of origin or at home, but we have had that be an integral part of our treatment and most of our clients have participated in this family relationship work. So I think that’s something unique to Opal that we’ve done adult treatment and then had this regular consistency with family therapy. And so I would love to just have you share what do you typically, what do you see when you’re in the room with these loved ones?
Nikki Wolf (04:30):
Yeah, there’s a huge educational component a lot of times, particularly with support people who are new to the eating disorder and recovery journey. A lot of what can I do to fix this? I would say if I had to pick a number one theme, the question how do I best support my loved one usually means how do I problem solve or fix this? And the education comes in with the Tuesday night group or in individual sessions, it’s more about that direct communication and maybe talking about the eating disorder directly or what the needs are within the system, how the family is working together, whether it’s teenager or adult with a partner coming in or roommates. We see all kinds of dynamics in Opal and that’s the one I think that we probably talk the most about, at least in the beginning. And there’s a lot of trepidation to go into uncovering patterns and talking about really uncomfortable stuff that might come up in the family session or the relationship therapy session. And so there is some building rapport, doing some education around eating disorders. What does family systems therapy look like? What does relationship therapy look like? It could look different ways. And then I would also say bumping up against support people’s own biases about what is an eating disorder, how to address it, and their own relationship with food and bodies and potentially disordered eating. That does show up a lot. Role of communication. That is a huge one too.
Kara Bazzi (06:22):
So you’re saying that maybe the posture of trepidation some concern, but the posture of what can I do to fix this quote problem that a lot of support people come in with. And what, I guess just to make sure the listeners are understanding what, can you say more about that dynamic of how we might address that posture of this fixing? Is that what we’re doing? Are we telling the support people what they can do to fix this eating disorder or how might we be addressing that very common way of showing up to treatment to start with?
Nikki Wolf (07:03):
That’s a great question. Typically, no, we’re not encouraging fixing it might. So I’m thinking about a family that I worked with and it was parents and a young adult. And I would say that this is a very common pattern to see with parents who are supporting people in our program because as a parent, it’s really hard, and I mean as a person in relationship, it’s hard to see our loved one struggling and in pain. And as a parent it can have its own set of challenges. And so it’s kind of maybe uncovering what if you can’t fix it, what’s the emotion driving that? There’s a lot of helplessness that comes in, a lot of acceptance around, well, this journey might look a lot different than I had hoped. And so my intent is to dig in to authentic communication around that and emotional expression, like open expression of emotion. We don’t always get there in the time that we have and that’s okay, but maybe introducing a new way of thinking about supporting your loved one might not be about problem solving or fixing or tell me about your day. I want to know everything. It might be, God, that sounds really hard. That’s bringing up a lot for me. What do I need to do to care for my own process in this?
Kara Bazzi (08:51):
Which when I hear you say that, I hear maybe for example, instead of fixing, you might be helping loved ones learn how to validate what’s happening for the other person and maybe working on caring for their own needs of what’s coming up in relationship with the person, for example. So that could be a different way of helping and supporting the healing of a system versus what can they do or say to fix the eating disorder.
Nikki Wolf (09:18):
Absolutely. I think the parallel process of learning that support people are doing is really important. And I think it’s also very meaningful to the clients who are in treatment and doing that own learning and examining of self and potentially getting their own help through therapy or support groups. That’s a lot of the feedback we do get in the Tuesday family relationship therapy support group is just how valuable it is for the support people to learn these new ways of being in relationship and practice it and potentially get closer to their loved one.
Kara Bazzi (10:01):
It makes me think of what so often happens in family therapy or family and relationship therapy is the loved ones might come in with a certain idea or expectation of what the work could look like and it’s not matching what that is. And some systems might feel resistant to that difference or welcome it be open, flexible. But I just think of, yeah, it’s often not where people might think the starting point is that it goes in a different direction of what the actual work of healing could be within that system.
Nikki Wolf (10:37):
Yeah, I mean the thinking sometimes they’ll come into the session and it’s a very heady, let’s logistically talk about this very rational, but your loved one has a need, has an emotional need that’s not being met. And so how can we start to communicate about that? So it’s also not just about the client that’s in our program. I try to be pretty clear when I start working with couples and different relationships, families, that the family is my client. We’re not, even though our client is in programming with us, if in the family relationship therapy setting, the family is the client and we’re there to talk about and to discover dynamics in that system, not just what the client is bringing with their eating disorder.
Kara Bazzi (11:39):
And maybe we could talk a little bit about, I know you touched on this, but what are other things that we might be addressing in those systems and those sessions? Because what we’re kind of addressing in those patterns in the system, and I know when I’ve been in that role, a family and relationship therapist, I am looking for patterns that these relationships have been stuck in and looking for ways to disrupt and to experiment and try things new and often it lands in the realm of communication, expression of feelings and what others, what other things? I think of what we just said earlier, the validation, learning, teaching people the skills of listening, again, not fixing. So that might be, we sometimes bring in this skill we call the move skill, which is about learning how to slow down, listen, validate and empathize, and really give people full turn to be able to do that in the moment of a heated conflict and then take turns doing it and really slowing someone down to try something different. And oftentimes the family therapist can be so useful because we can disrupt these patterns and give a timeout and try something different. So what else would you say in that vein? Are things that you’re doing in the room that would be common, things you’re disrupting or introducing that these relationships hadn’t experienced yet?
Nikki Wolf (13:14):
I mean, everything you just said about disrupting, I’m like, yes, I do that. That’s my primary goal. And that I would say when there’s a lot of trauma in either with one person in the room or both people in the room, there’s something that happens when conflict starts or disagreement or an argument that tends to happen over and over again where I’ve seen clients kind of revert back to their wounded self or the trauma self. And so we might be, I would say observation is my main job. I’m observing what’s happening. I actually really like it when I can see a dynamic play out because then I can say, okay, I just saw this is what I saw. And it might be like, did you notice that your partner shut down when you said this? And so it’s noticing bringing attention to things that they can’t be aware of in the moment because they’re in the pattern.
(14:38):
And I like the disrupting, say, if you’re relating to your partner and they are in their trauma self or wounded self, there’s no conversation to be had in that moment. So I know I’m actually thinking of a specific couple I worked with where that was really useful. I like to tell people I’m working with that as humans, we tend to get lost in the content of, okay, you said this and so then I said this and then you said this, and it’s like, we don’t need to do that. What are you feeling? What did it feel like when the other person said the thing getting into the hurt that’s happening or the story behind it? Because what’s said is kind of irrelevant At the end of the day when the reactions are happening, our next response comes from the reaction that we’re experiencing from hearing the thing.
Kara Bazzi (15:44):
So yeah, seeing a pattern, and in this case that you’re describing, helping illuminate something that’s deeper, that’s getting missed by what is the emotion underneath so that there can be maybe more understanding, more connection, more vulnerability,
Nikki Wolf (16:01):
Or even just stopping this cycle that is making each person feel like they’re not being heard. It’s like, okay, well they can’t hear you right now because they’re in their trauma response. So being able to recognize that and say, this isn’t a conversation we can have right now, let’s try again later when we’re both more present because I think the not feeling heard, not feeling seen, these are big themes that come up as well because again, I feel like people are like, but I do hear you. You’re saying this and it’s like, I don’t think you’re getting to the core of what it is you’re feeling. And that is also take self-awareness with the client or whoever is trying to express their need is they need to know what is happening. And often sometimes they don’t.
Kara Bazzi (16:57):
Yeah, I’ve experienced this a lot in family work where, and I just think this is a normal human pattern. When two people care deeply about something and they’re just clamoring to be heard and they’re talking over each other and they’re focused on what they want, what they need, and the other person’s focused on what they want and they need, both people are missing each other. And so those are very powerful moments in family sessions where a provider can again, slow them down, give each person space and the skills for the listener to really hear the other person and know that they’re going to have their turn. I think that is often what we just all want to be paid attention to and understood. So I think that I can think of many moments in sessions, that’s what I might be doing with relationships in the room.
(17:55):
I also wanted to add to the thing you said about being kind of in trauma response. I think also when we’re in just heightened emotion, so if we’re in an arousal zone, we think about if somebody is in the red with their anger or if they’re kind of just in such an arousal zone that they can’t listen again, we can reflect that back of what’s happening and pause that moment and not keep the conversation going. And oftentimes that’s when people say more hurtful things that they don’t even mean and create more distress in the dynamic than is needed because they’re in this state, this just in this physiological state that they’re not going to be effective communicators. So we can kind of point that out and help them slow that down and then actually feel that in a room so that they can take that away in the week ahead where they’re at home or in a different space to practice something different.
Nikki Wolf (18:54):
I like the slowing down and curiosity. I read a lot of nonverbal cues too, and that happens in the group, larger group setting to leading groups. But I can think of some families with young adults and parents I’ve worked with where I notice one parent is talking and the young adult is over there making faces. And so I’m kind of like, oh, hey, I’m noticing a thing. What is that? What’s going on? And that’s something that they’re not asked because, and I’m going to say I’m not great at that myself with my own kid, but it’s different when you’re facilitating other people, but giving space and noticing and allowing them to then explain, well, you’re falling into lecture mode or that something’s missing.
Kara Bazzi (19:54):
And that reminds me of what you said earlier about being an observer. You’re able, because we’re removed from the emotional place of that relational system, we can see there is just a little bit easier to see what is playing out in a room. Sometimes we get involved in the dynamic and we get emotionally kind of pulled. So that’s another interesting piece about being in this role as therapist. So
(20:24):
Yeah, another pattern or another way I see us as in our role as family and relationship therapists is that of interpreter. So again, that observational step and then helping navigate different temperaments in the room, different human beings, and maybe sometimes things get lost in translation and we might be able to have, again, a little bit more of a removed perspective to help maybe interpret on behalf of different types of people, different temperaments, et cetera. I don’t know if you have anything you’d want to say around that, but I feel like that is another place of something we’re offering in the family and relationship space.
Nikki Wolf (21:11):
We’re not in it, we’re not in the dynamic. So I just find why wouldn’t you want someone else? I’m the family and relationship therapist, but why wouldn’t you want someone else to say to be on the outside? It can be validating for some, and sometimes people do feel called out and that does come up. And I would say that it’s not typically just one person being called out all the time, but different people can be in the system can be called out, and that’s okay,
Kara Bazzi (21:45):
But let’s go to that because I think that there is particular energy around the parent child dynamic. And I think partially because of what you’re saying is generally, I think especially when your kid is suffering with an eating disorder, often a parent is going to be concerned about being blamed for it, and they could feel a lot of guilt either, a lot of guilt and feel really kind of tender about it or very defended and not want to feel responsibility, but there can be a lot of energy around this whole blame blame thing. So I’d love for you to be able to speak about your experience with that around that particular dynamic. How do you navigate it in a session when you notice that a parent is really sensitive around the blame of whose responsibility is it?
Nikki Wolf (22:46):
Yeah, I think that what I’m trying to do, and I will communicate this with people when I feel like maybe when I sense that there is some of that happening is we’re not here to blame, but what we want to do is bring these patterns out into the open. And when we think of from a Bowen framework, it’s about shedd light shining a light on the patterns and how we are perpetuating and contributing to them. So not placing blame necessarily, but often some of these patterns are generational and the parent is learning from their parent or their systems and so on. So I have had that feeling in where, okay, I’m getting a sense that the parent is feeling like there’s a lot of blame being put on them. And I try to kind of back it up a little bit and explain this is the intention behind that, and I understand it feels uncomfortable and there is a part you’re playing, but we are not going to solely blame one person or two people, our caretakers. And most of the time that helps kind of smooth things and let them get there. And there have been times it hasn’t where they just haven’t been able to go there and it’s like, okay, they’re not ready to do that right now and we can’t force them into it. So then it’s kind of about turning to the client, what do you need to feel supported and safe in this relationship knowing that your loved one can’t do this right now? And trying to approach that with non-judgment
(24:54):
Too.
Kara Bazzi (24:54):
I’m glad you’re bringing this in and just FYI for context, Bowen is a family therapy modality. You could look it up if you’re interested, but this idea of us finding some momentarily dead ends, I know from the way I approach it, sometimes we kind of find a limit and I don’t ever want to say to anyone that this is a limit that will last a lifetime, but for now, we’re hitting a limit potentially of where someone’s willing to go in the family work. And like you said, with non-judgment of this is, it just is what it is, and now how do we want to approach this? And that happens all the time where we might kind of bump up against somebody’s limit.
Nikki Wolf (25:42):
And one thing I do like to talk to support people and clients about is, Hey, you’re in a higher level of care program right now and you’re here every day getting this all day, and your support person is maybe once a week, maybe twice a week if they’re also going to the group and doing sessions and possibly more if they’re really motivated to do their own self-learning. But the rate of learning and adjustment is not going to be equal. So just reminding people they’re trying to do it and it’s going to be a slower process than what you are experiencing here in this program, and it just has to be
Kara Bazzi (26:30):
That way. And yeah, I’m again glad you’re saying that. I think that when we explicitly say that to the loved ones and the clients together, I just think there’s something really relieving and leveling about it because it is true and it’s just naming what’s true. And I think that’s really important just from an expectation standpoint that we’re working with something lopsided and that I just, again, I think that’s very kind to be explicit about to the system because often our clients want the loved one to just be right up there with them and doing the work at the same rate and the same intensity and it’s just not going to happen.
Nikki Wolf (27:14):
No. And also that sometimes the clients are having a hard time with buy-in around how we’re reframing food and bodies and all of that, and that takes time even when they’re in 10 hour programming. And so kind of think about, well, if they’re only getting this once a week in this group and they’ve had decades of this messaging and this conditioning, then it’s going to be a little bit more of a process for them to, and they might never really get to that.
Kara Bazzi (27:49):
Let’s kind of maybe jump to that around the ways we’re opening up systems for change, the ways we’re opening up for healing. We’ve talked about changing of communication patterns. We see lots of growth. Let’s talk more about the side of acceptance. So the witnessing that we might have or the work that we might be doing with our clients around being a piece of witnessing what is happening in the system, and again, not maybe acceptance for a lifetime, but acceptance for the moment of this limit. And how we also see that as part of the healing work makes me think of, I mean, I’ll just say briefly myself, the clients that come and just putting their hand on the stove and keep trying over and over to change something within somebody that they love and they just keep, they’re not recognizing the limit and how that’s not serving them and that’s actually maybe harming them in their recovery. Do you have it an example of that or do you want to add to what I’m saying? Or do you have an example of work you’ve done where you’ve, it’s been more about witnessing and helping the client kind of come to some acceptance about what they can’t get?
Nikki Wolf (29:08):
Yeah, I mean multiple, yeah, examples come to mind and the specific examples I’m thinking of are younger clients, younger adult clients because it’s been more of a parental acceptance around, I didn’t have the mom I wanted, I didn’t have the dad I wanted and I really just want them to be this way. And maybe we’ve tried doing the work and the parent just, isn’t it the caretaker’s just not getting it? And sometimes there’s real desire there, they really want to get it, but they’re just where they’re at and they’re not always getting it in the way that the child or the client is hoping that they will. And so then sometimes we will pull back and maybe do some one-on-one work around what is it that you are needing? If you’re going to be a participant in this relationship and you want to continue in this relationship, sometimes there’s financial dependence as well.
(30:19):
And so there isn’t choice around that. And so, hey, how can we, let’s explore what it is that will feel like enough right now. And I like what you’re saying about this is the limit for now. It is not always the limit. Maybe down the road there will be a different opportunity. And I think opportunity is the word that comes up when I think about doing family relationship work is we’re not necessarily creating change, but we’re creating an opportunity for change to happen because the change is by choice. And we’re kind of opening this door and saying, here’s a chance for your system to evolve. And some folks walk right in and some don’t. So
Kara Bazzi (31:14):
Yeah,
Nikki Wolf (31:15):
And I would say on the flip side of acceptance is from the caretaker or partner or loved one perspective, particularly around eating disorder and treatment. And there might be acceptance of this might not look how I hope it looks. I do see a fair amount of parents that are kind of cheerleaders and they’re like, you got this and you’re strong and you’re smart. And just plow through it and kind of like, let’s talk about the reality of, or the possibility if we even just talk about impossibility, what if it isn’t done in eight weeks? What if it isn’t done in three months? What if your child has to defer school? What if they make that choice? So I think that’s a piece that loved ones really the acceptance around that can be really hard to come to.
Kara Bazzi (32:18):
Definitely. Yeah, there’s a lot that we’re getting at in this. I was thinking when we were talking about that acceptance piece of some on the client side where there there’s this fantasy, I wish my mom, I wish my dad could be kind of exactly this way or come alongside this new way of thinking around health at every size or weight inclusion and kind of live and breathe it themselves. And if they can’t, I can’t be in relationship with almost this kind of black and white. You’re either doing it fully or how could I bear to be in relationship with you? And if we come across a limit of a parent isn’t ready to change the way that they view food and body, I think as an FRTI often, I want to give a lot of freedom to the loved one. They get to make their own choices. But from a client’s perspective, I think some of the work we might be doing is grief, grief work to, even if we can’t grieve that, then it’s hard to get to a place of acceptance. And when we get to acceptance, we can live in more of the gray of, I can still now actually appreciate some of the lovely pieces of my parent and not just be angry all the time that they’re not exactly this vision of perfection that they might want. So
(33:52):
That can be really meaningful work
Nikki Wolf (33:56):
Accessing the grief. Also grief in the example I was using from the parent side of realizing that your child may not be living the life that you had hoped for or envisioned for them and getting to the grief in that too. And even with the client, they’re probably not living the life they had envisioned for themselves either many times. So getting to the grief, I think, yeah, grief is a huge part of this work. Totally,
Kara Bazzi (34:28):
Yes. Okay. Well, let’s change gears a bit and talk a little bit about, I mentioned earlier our recent shift towards working with more adolescents and starting to work with adolescents age 16 and older. And we’ve worked with Opal anywhere from age now We have a 17. We we’ve had 70th through 17 all the way up to 74. So I’d love to talk about how relationship therapy might change what that could look like through these different developmental stages because obviously an adolescent, their brain is developed, they’re not fully formed adults, and then all the way up to 74 and thinking about end life back more in an end of life type of approaching that stage. Yeah. Is there anything you’d want to share about patterns or thematic things that might look a little different from an age perspective?
Nikki Wolf (35:30):
Yeah, I mean, I love working with all systems, but I feel like I have special place for families of young adults, particularly those who are preparing for launch or mid-launch. It is a really challenging time of parenthood and still requires a lot of attunement, but in a way that is a lot more confusing than when they’re 12 or in pre-adolescence. I had say for the 16, 17 year olds, they’re still living at home. There’s still an authority relationship with caretakers that is hopefully lessening as they get to 18, 19, 20. And of course it’s developmentally appropriate for people this age to be looking more outside of the family system for validation, connection, all that kind of stuff. So it’s like how do we do that dance? And also there’s this idea that when our kids turn 18, it means something like they’re fine now. They’re adults, they’re going to college. Maybe they’re not adults. They’re not adults yet.
Kara Bazzi (37:04):
I have an 18-year-old right now who is graduating in a month. I’m right on it.
Nikki Wolf (37:10):
I have a 21-year-old, and she’s of course different than an 18. And there’s still a lot of management happening. And so I love to work with parents and caretakers that are in that phase to kind of be like, well, there’s grief here because you’re soon to be an empty nester or your kids are growing up, they don’t need you in the same way. And just noting, this is when I went back to grad school because this is when I switched careers, so let’s acknowledge that, but your child is wanting independence and freedom. And so we want to also honor that. I think kids, sorry, the young adults sometimes are kind of like, I just want ’em to leave me stop texting, so stop. And I’m like, Hey, they’re not going to stop caring just because you’re turning 18. They have needs too. So working in that system to find the balance, and maybe it changes week to week, but having that line of communication open in a way that works for both people and there’s an eating disorder involved and there’s an eating disorder.
(38:36):
I’m even mentioning the eating disorder. So then there’s that. Yeah, and I think that with the younger clients having the eating disorder component too, there is kind of more of the parental control, parental authority, but we’re still walking that line of they are going to be launching soon if that’s their vision, if that’s what everybody’s hoping for. And so how are we going to do that? And it’s challenging and I really like doing that, and I don’t think that there is a lot of focus on that piece of it is of both things are true and valid. And I’ve heard from some caretakers that there is talking about acceptance and grief of realizing there’s a point where they just have to let go of any control or expectation and realize that your kid’s going to live your life and hopefully they’re just doing the best they can and you don’t want them suffering and struggling. And if they are, there’s only so much you can do to change that for them. So that’s the younger folks,
Kara Bazzi (39:53):
And maybe I’d add in that or ask a question for parents that are going through that launching phase or the young adult side and then their kid has an eating disorder. I think the intuition would be like, now I am getting more involved again because they are sick, they are ill, they need help. I’m their parent. I care, of course, I care deeply about my child who is suffering, and yet they’re still in that stage. And I think that is just this weird, so it’s already so layered if somebody isn’t is well and launching because obviously they still need things. My daughter still needs things. They’re not fully independent. But then there’s this urge to parent more obviously when an eating disorder is there. So I guess would you, you be encouraging the parents in a system like that, they don’t have to double down on the
Nikki Wolf (40:58):
Caretaking? Yeah, I mean I actually see this not even with just the minor clients, but clients who are young adult and have been in adolescent treatment where there’s a heavy focus on parent involvement and support, and parents are essentially controlling. They’re in charge of the food and all the care at home, and then they turn 18 and they come to adult treatment and we’re like, guess what? We don’t have to tell you stuff anymore. And that is really, really, really hard. So sorry, I forgot your question. I don’t know where I was going.
Kara Bazzi (41:40):
Yeah, I was just curious if you would basically say you don’t double. There is still part of letting go and working through a launch and it seems so confusing for a parent of how do I navigate that? Am I just letting my child flounder as they’re off in college? Do they just need to be home and nurtured by me 24 7?
Nikki Wolf (42:10):
I think it’s sort of like there’s still maybe a doubling down for a period of time, and then the work is gradually handing it back to the client and then we are here to help you if you need help. If they get to the point where they go through treatment and they’re feeling well enough to go off to college and then they go to college and they tank, it’s being available being we’re here to help you. We will be there. We’re going to check in. Maybe that’s the agreement that we’re trying to come to is how much of your parents’ attention is feeling like enough or too much? And from the caretaker’s end, how much and response do you need from your loved one, from your kid to know that they’re okay? And so coming to that agreement, and I think that many parents do want that launch to happen and obviously for their child to be well to do it, and maybe talking about what does well look like to you and what if they’re recovered enough in the moment or maybe they could use more treatment, but they’re choosing to not defer school or go to school.
(43:36):
So how are we going to address that? So yeah, right now there are, because we get so many 18 to 25-year-old clients, there are many cycling through my head right now, including younger and things that we’ve focused on with them. And I would say that more often than not, the caretaker’s desire is for their child to be launching and trying to get to a place where they feel stable enough that that can happen safely.
Kara Bazzi (44:17):
And like you said, that negotiation, there isn’t one way of doing that negotiation.
(44:21):
It’s going to look so different for any kid and parent system. There isn’t one. How much support is the family system giving so varying depending on the unique individuals at play. And I would also say a thing that comes up frequently is the support that a parent gives or support a loved one gives isn’t static. It’s going to change what the loved one needs can change. So week to week, day to day, we always get the what can I do to support, what can I do to help? There isn’t just this program you do for the next two years, it’s ever evolving. It does require a lot of communication. It does require the person struggling with the eating disorder to communicate that to the loved one. You don’t have to guess. It’s not about reading somebody’s mind. It really does. That’s what we as providers are helping our clients do is how to share, connect with what they need and share it with the people in their life so that the loved ones don’t have to do all the guesswork
Nikki Wolf (45:29):
Because
Kara Bazzi (45:29):
That’s not helpful.
Nikki Wolf (45:30):
I think that actually is a theme that comes up a lot, particularly with in marriages and partnerships, like romantic partnerships of how will I know when my partner is struggling, what cues should I be looking about for? And I am like, we’re not mind readers because one person’s cues are not another person’s cues. So I can’t help you read their mind better. Sorry. So then we do talk about that direct communication, practicing direct communication. And it’s very nuanced too. Some people think of it more as monitoring certain questions. How do you ask questions? What questions to ask? Because hey, don’t monitor me. Don’t ask me questions about my food. Don’t ask me questions about this. How much am I eating? And there are other people who are like, yeah, will you ask me questions about my food? And so there isn’t just that one
Kara Bazzi (46:42):
Size does not fit all.
Nikki Wolf (46:43):
Yeah. So that’s a thing we talk about a lot in the support group is because they’re like, how do I know? What are the red flags? And we have to say, well, I don’t know what your person’s red flags are. They know and hopefully are talking about that before they discharge. And maybe you could ask them why didn’t you ask them directly? And they may share and they may not.
Kara Bazzi (47:12):
That’s so true. Other, I know we’ve been talking about more that launching stage. Was there anything you did want to say about other life stages?
Nikki Wolf (47:21):
Yeah, I think my approach later in life, some people still do work with caretakers, parents and family of origin, but I’m thinking of some couples that I’ve worked with where we are talking still, we’re talking a lot about family of origin stuff. What have we learned about relationships from our families that we grew up in and how are we bringing that into this dynamic here? And I know that trauma has played a big role in that as well, trauma experiences. So how is that adding to dynamics that are coming up and patterns that are coming up? You mentioned we’ve had clients up to age 74 and I have worked with older couples and the generational influences are very real around diet, body food. So we may not be completely dismantling that stuff, but bringing in new ideas and new ways of interacting, communicating always comes back to that communication.
Kara Bazzi (48:36):
I mean, we could be talking about this all day. It’s very fun. We like talking about family therapy. Yeah, I love it. And I’m wondering if there’s anything just for now that you’d like to share that’s been missing from this conversation. Is there anything you’d want to make sure is kind of in the context of this episode?
Nikki Wolf (48:56):
Yeah, I think maybe I mentioned earlier about the system, and by system I mean whatever family unit or relationship unit probably should have said that earlier that you’re working with. But the unit being the client and a good family relationship therapist will not collude with either individual within that unit. And I think that’s really important. And it’s something I try to be really clear about when I start working with people, especially when there are parents involved, because they might want to email me and get information. And so I say, if you have questions, you can email me. Or if you have things you want to bring in, you’re not really sure how you want to bring them into session, you can let me know. But if you email me about other stuff, I’m going to respond and CC your loved one for transparency and say, this would be a great topic to discuss in our next session.
(49:57):
And because we’re in a unique situation with the higher level of care, we’re not outpatient providers. And if I were an outpatient provider, I would only be seeing the family once a week. I wouldn’t know about other aspects of their care. But because we’re a kind of a more closed system and we’re consulting all the time on a treatment team level, I do know more, but I let the family know that I’m not meeting with this person. They have their own individual therapist. They’re having sessions with their other providers as well. And so I am meeting with this client while I’m meeting with you. So I think that’s important for people to understand too, is how the attitude of the therapist coming in and how they’re holding the individuals within. Right,
Kara Bazzi (50:53):
Right. And I’m glad you said that because it does highlight that we did make that decision from the get-go with Opal to have a separate primary therapist and separated from the family and relationship therapist for that exact point that the family and relationship therapist is for everybody in the room. And we can’t have zero bias going in, and we will know a little bit more about the client, but it’s really important value of ours to be doing true family therapy, which would be that we are there for each person in the room. And so that’s why we set it up structurally to have a different therapist. And that may make us, I know maybe other treatment centers do that as well, but sometimes the treatment centers have the primary therapist be the family therapist, but that was, we chose not to go that direction for that exact reason. Yeah.
Nikki Wolf (51:47):
Yeah. I mean, for me personally, that would be a really rough line because sometimes even now I get information from the team and I’m kind of like, I can’t just bring that in. That needs to be brought in by the families. So it can be tricky, but I don’t personally feel like it’s hard for me. It’s just an interesting addition to what we’re doing. Totally.
Kara Bazzi (52:22):
Yeah. Okay. Nikki, if our listeners are interested to learn more about family systems work from this awesome conversation with eating disorders, do you have any resources to point them to? Anything you want to say out loud that we can link in the show notes?
Nikki Wolf (52:37):
Yeah. The Opal website, Opal Food and body.com has an FRT page family relationship therapy page. And there are a lot of resources for books, podcasts. It’s an evolving list, so things will continue to be added. And I am going to begin to offer an outpatient family and relationship therapy support group, just, which is, I’m calling it FRT Support Group 2.0, which is very similar to the one we offer in program, but it will be for outpatient. And that is a combination of learning, education and process. So just sharing experiences about what it’s like to be a support person of somebody going through this journey with some learning involved too. So that can be accessed by contacting me directly, nikki@wolfheartcounseling.net is my email address for people who are interested in, I do have a website under construction right now, and we’ll be up soon and then Feast the online forum geared more towards caretakers of adolescents as a good resource as well.
Kara Bazzi (53:57):
Great. Yeah. Awesome. Well, thank you for being in this conversation today on our podcast. It
Nikki Wolf (54:03):
Was fun. Thank you for having me talk about
Kara Bazzi (54:04):
All things family relationships, and if you’re again interested in these resources, Nikki sharing, it’ll be linked in the show notes. If you’re interested in Opal and want to learn more, please visit us at opal food and body.com. Thanks to David Bozzie for editing, Jack Straw Cultural Center for Sound Engineering and Aaron Davidson for the Appetite’s Original Music. See you next time.
